Background <p>Bear bites often cause serious injuries to patients such as on the face, neck, limbs, head and other parts, resulting in difficult airways and presenting great challenges to anesthesia management.</p> Case presentation <p>This paper reports a case of a 35-year-old Tibetan woman who was severely injured on the face by a bear’s attack while grazing, resulting in a difficult airway. Awake tracheal intubation was adopted and tracheostomy was performed during the operation. Airway management of the patient was successfully carried out. During the initial hospitalization, there were no complications related to tracheal intubation in any of the 9 operations, and the patient was discharged smoothly.</p> Conclusion <p>The key to ensuring the safety and success of the operation is to develop an personalized anesthesia plan based on the specific situation of patients in the difficult airways caused by complex head and face trauma caused by bear bites.</p>